In Cushing\u2019s disease, the rate of endocrine remission after surgery reaches about 80% in expert centers. However, due to the tumor\u2019s ability to invade surrounding dural structures, hypercortisolism persists in 20% of patients or recurs in 15%. To improve remission likelihood, tumor resection can be extended to the dura in patients with basal dura invasion. The aim of this study was to evaluate the benefit of a surgical strategy based on a systematic focus on the basal dura.<\/p>\n\n
Endoscopic surgery was performed in 89 adult patients without obvious cavernous sinus invasion. The basal dura was systematically removed whenever macroscopic invasion was suspected. Three groups were defined: (i) resected but non-invaded dura (n=14); (ii) resected and invaded dura (n=16); and (iii) non-resected dura (n=59). The cohort was compared to a personal control series of Cushing\u2019s patients operated without a systematic focus on the basal dura.<\/p>\n\n
The mean follow-up duration was 19.9\u2009\u00b1\u20099.4 months. Endocrine remission was achieved in 15\/16 (94%) patients with invaded dura, 14\/15 (93%) with resected non-invaded dura, and 50\/59 (85%) with non-resected dura. Anterior pituitary deficits and diabetes insipidus occurred in 3% and 9% of patients, respectively. Compared to the control series, the remission rate was significantly higher (88% vs. 75%, p\u2009=\u2009.019).<\/p>\n\n
Tumorectomy extended to the basal dura is a safe procedure that maximizes surgical resection. Despite dural invasion, endocrine remission remains high when the dura is removed. A systematic focus on the basal dura can thus optimize endocrine outcomes in Cushing\u2019s disease surgery.<\/p>\n\n